Karina Tenorio

Claims Administration & Compliance

• Provide exceptional customer service and support in a fast-paced environment by proactively liaising with clients, vendors, and internal teams, clearly communicating claim status, required documentation, and any arising issues.
• Serve as the primary liaison between insurance carriers, healthcare providers, external legal counsel, and internal teams to facilitate efficient claim resolution and gather additional information as needed.
• Oversee end-to-end administration of insurance claims, ensuring timely and accurate submission of reports and documentation, and following up on outstanding materials required for processing.
• Maintain accurate records of all claim transactions—including correspondence, documentation, and decisions—and uphold a comprehensive claims database by reviewing and updating claim statuses, processing denials, and initiating rebills to optimize reimbursement.
• Collaborate with insurance payers throughout the claim lifecycle to secure accurate and timely payments, prepare documentation, and assist in appeals processes as needed.
• Process and audit claim adjustments within the Florida Medicaid Managed Information Systems (FLMMIS) and Availity, ensuring data accuracy and adherence to relevant regulations.
• Verify insurance eligibility and manage medical billing in FLMMIS and Availity, securing preauthorization for services while maintaining compliance.
• Protect patient confidentiality by upholding HIPAA standards in all data review, entry, and storage processes.
• Ensure compliance with the organization’s coding procedures and standards, upholding a high level of knowledge of current coding guidelines and staying current with Medicaid, TRICARE, and private insurance policies.

Contract Management & Partnerships

• Negotiate, complete, and revise contracts for provider status with various health insurance companies, fostering profitable partnerships.

Talent Development & Leadership

• Facilitate new-hire onboarding by obtaining Medicaid Provider numbers and coordinating credentialing with private insurers.
• Lead training, development, and mentorship for new hires, ensuring a thorough understanding of billing processes, insurance regulations, and company policies.
• Direct full-cycle personnel management, including recruitment, one-on-one coaching, and terminations as needed.
• Manage employee certifications and mandatory trainings, ensuring timely completion and compliance with payer and healthcare provider requirements.

Volunteer

· Coordinate field trips by researching and contacting various attractions, organizing fundraising initiatives to help parents offset costs, and managing all payment collections and weekly deposits.

· Serve as a substitute teacher by implementing lesson plans, delivering instruction, reviewing classwork and homework, planning recess activities, providing one-on-one support, and keeping parents informed of student progress.

Office Manager

· Provide exceptional customer service by proactively anticipating and addressing client needs, resulting in increased satisfaction and retention.

· Establish and maintain strong relationships with multiple delivery companies, ensuring timely, accurate, and cost-effective deliveries.

· Negotiate the procurement of office supplies and other goods within budgetary constraints, ensuring compliance with company policies.

· Analyze daily, weekly, and monthly inventory reports to manage stock levels, identify trends, and streamline operations.

· Oversee office administration tasks, including bi-weekly payroll preparation, company correspondence, records management, and approving supply requisitions.

· Ensure accuracy in financial processes by performing timely data entry for purchase orders and invoices.

· Supervise and coordinate daily responsibilities for both warehouse and office personnel, promoting efficient workflows and adherence to company standards.